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Iwami D, Matsumoto T, Ono K, Hotta K, Ota M, Chiba Y, Sasaki H, Hirose T, Higuchi H, Takada Y, Iwahara N, Murai S, Shinohara N. Novel double-filtration plasmapheresis preserves fibrinogen while removing immunoglobulin-G antibodies before ABO blood type-incompatible kidney transplantation. RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00379-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Abstract
Background
Removal of anti-blood group antibodies is important for successful ABO-incompatible kidney transplantation (ABOi-KTx). Double-filtration plasmapheresis (DFPP) using albumin solution removes antibodies effectively. However, fibrinogen is largely removed resulting in hemostatic failure. Herein, we designed an altered combination of plasma membranes in DFPP (novel DFPP, nDFPP) to retain more fibrinogen while removing IgG, and assessed its efficacy and safety compared with conventional DFPP (cDFPP).
Methods
Consecutive ABOi-KTx recipients (from 2015 to 2018) were enrolled. For the first membrane, we used Cascadeflo EC-50W in nDFPP and Plasmaflo OP-08W in cDFPP, and Cascadeflo EC-20W as the second membrane in both modalities. Removal rates (RR) of IgG, IgM and fibrinogen per DFPP session, and adverse events were compared with historical control patients who underwent cDFPP before ABOi-KTx, between 2006 and 2015.
Results
nDFPP and cDFPP groups included 12 and 23 cases, respectively. nDFPP was inferior to cDFPP in RR of IgG and IgM. nDFPP was also inferior to cDFPP in the decline in anti-blood group IgG and IgM antibody titers. However, fibrinogen was more preserved in nDFPP compared with cDFPP, indicating that nDFPP has more selective removal properties (median RR of IgG, IgM, and fibrinogen: 62.1%, 15.7% and 37.6%, respectively, in nDFPP; and 74.5%, 85.0% and 76.6%, respectively, in cDFPP). In the comparison of hemostatic function among the patients who had arteriovenous fistula for hemodialysis, prolonged hemostasis (> 20 min) at the cannulation site was significantly less frequently observed in nDFPP group (1 in 9 cases, 9.1%) than in cDFPP group (all 18 cases, 10%, p < 0.0001).
Conclusions
nDFPP preserves fibrinogen while removing anti-blood type IgG antibodies before ABOi-KTx.
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Naciri Bennani H, Noble J, Chevallier E, Terrec F, Motte L, Giroux-Lathuile C, Bugnazet M, Imerzoukene F, Janbon B, Malvezzi P, Rostaing L, Jouve T. Isoagglutinin removal by plasma centrifugation or filtration (single or double): A prospective study in a single center. J Clin Apher 2020; 36:149-160. [PMID: 33230824 DOI: 10.1002/jca.21857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 10/27/2020] [Accepted: 11/11/2020] [Indexed: 01/28/2023]
Abstract
INTRODUCTION ABO-incompatible (ABOi) kidney transplantation, a well-established procedure, has good long-term results provided pretransplant desensitization that includes immunosuppression and apheresis. OBJECTIVE To compare, within the first pretransplant apheresis session given to 29 ABOi kidney-transplant candidates, the effect on isoagglutinin titers (both IgG and IgM isotypes) of three modalities: centrifugation therapeutic plasmapheresis (cTP; n = 10), filtration TP (fTP; n = 9), and double-filtration plasmapheresis (DFPP; n = 10). RESULTS The three groups were comparable according to baseline demographics. Treated plasma volumes were similar across the three groups, that is, 4111 ± 403 mL (cTP), 3861 ± 282 mL (fTP), and 3699 ± 820 mL (DFPP): that is, 54 ± 7, 53 ± 7, and 53 ± 10 mL/kg respectively. One session of centrifugation or filtration TP reduced IgG anti-A/anti-B isoagglutinin titer by ~4, whereas one DFPP session reduced it by ~2. One session of cTP reduced IgM anti-A isoagglutinin titer by a little less than 4, whereas fTP and DFPP sessions reduced it by ~3. There were no statistical differences across the three groups regarding isoagglutinin rebound (IgG and IgM). However, isoagglutinin IgG rebound was >4 dilutions for anti-B titers compared with ~2 dilutions for anti-A titers. The median decreases in IgG level were -3.9 g/L (DFPP), -5.9 g/L (cTP), and - 6.06 g/L (fTP) (p = ns). Median fibrinogen depletions were ~ 60% (fTP), 64% (DFPP), and 76% (cTP). CONCLUSIONS Isoagglutinin depletions within the first apheresis session were similar across cTP, fTP, and DFPP: this was numerically lower for DFPP.
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Affiliation(s)
- Hamza Naciri Bennani
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Johan Noble
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Eloi Chevallier
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Florian Terrec
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Lionel Motte
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | | | - Mathilde Bugnazet
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Farida Imerzoukene
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Bénédicte Janbon
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Paolo Malvezzi
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Lionel Rostaing
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France.,Université Grenoble Alpes, Grenoble, France
| | - Thomas Jouve
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France.,Université Grenoble Alpes, Grenoble, France
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Chuliber FA, Penchasky D, Santoro DM, Viñuales S, Otero V, Villagra Iturre M, Privitera V, Mezzarobba D, Burgos Pratx L, López MS, Barrera L, Schutz N, Arbelbide J, Martinuzzo M. Acquired factor XIII deficiency in patients under therapeutic plasma exchange: A poorly explored etiology. J Clin Apher 2020; 36:59-66. [PMID: 32942343 DOI: 10.1002/jca.21840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/19/2020] [Accepted: 09/02/2020] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Factor XIII (FXIII) deficiency may cause bleeding under certain clinical circumstances. Therapeutic plasma exchange (TPE) may lead to a transient deficiency. OBJECTIVES To describe the clinical evolution of patients with acquired FXIII deficiency secondary to TPE. METHODS We respectively studied a cohort of consecutive patients from 2014 to 2019 who were treated with TPE with FXIII levels <50%. The FXIII was measured after the start of the TPE course, on days between the TPE sessions, due to suspected acquired deficiency. All TPE were performed using continuous flow cell separator. In all cases, the initial replacement fluid applied was albumin. Apheresis procedures were held at 24to 48 hours intervals. RESULTS Eighteen patients were included, 13 of them were recipients of kidney transplants. The main TPE prescription was humoral rejection. Median FXIII at diagnosis (measured on days between sessions of the TPE course) was 19%(IQR17-25). The median of apheresis procedures before measurement of FXIII was 3(IQR2-4). Among the total cohort, 10 patients suffered hemorrhages. None of the patients without history of kidney transplants had bleeding (n = 5), however, 10/13 with kidney transplants did. Five kidney transplant patients received therapy with FXIII concentrate because of life-threatening bleeding. In all cases, the bleeding stopped within the first 24 hours. All patients had their FXIII levels measured again after finishing the TPE course, with normal results. CONCLUSIONS TPE is an under-diagnosed cause of acquired FXIII deficiency since routine coagulation tests remain unaltered. It might cause major bleeding, particularly in patients with a recent history of surgery like kidney transplants.
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Affiliation(s)
| | - Diana Penchasky
- Section of Hematology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Diego Mario Santoro
- Service of Transfusion Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Susana Viñuales
- Section of Hematology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Victoria Otero
- Section of Hematology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Verónica Privitera
- Section of Hematology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Daniela Mezzarobba
- Section of Hematology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Leandro Burgos Pratx
- Service of Transfusion Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marina Sol López
- Department of Applied Biochemistry, Section of Hematology and Hemostasis, Central Laboratory, Hospital Italiano de Buenos Aires. Instituto Universitario del Hospital Italiano, Buenos Aires, Argentina
| | - Luis Barrera
- Department of Applied Biochemistry, Section of Hematology and Hemostasis, Central Laboratory, Hospital Italiano de Buenos Aires. Instituto Universitario del Hospital Italiano, Buenos Aires, Argentina
| | - Natalia Schutz
- Section of Hematology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jorge Arbelbide
- Section of Hematology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marta Martinuzzo
- Department of Applied Biochemistry, Section of Hematology and Hemostasis, Central Laboratory, Hospital Italiano de Buenos Aires. Instituto Universitario del Hospital Italiano, Buenos Aires, Argentina
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Effectiveness of Factor XIII Infusion in Treatment of Refractory Ureteral Leakage after Kidney Transplantation. Case Rep Transplant 2020; 2020:1780760. [PMID: 32724697 PMCID: PMC7381963 DOI: 10.1155/2020/1780760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/19/2020] [Accepted: 07/03/2020] [Indexed: 11/17/2022] Open
Abstract
Despite the evolution of transplantation techniques, urological complications are common and result in loss of graft. We report the case of a 57-year-old man who developed continuous urine leakage despite pyeloureteral neoanastomosis and stenting after kidney transplantation from his dizygotic twin. Suspecting ureteral leakage, we performed pyeloureteral neoanastomosis using his native right ureter and a ureteral stent 5 days after the kidney transplant. However, urine leakage continued for several days. Because the plasma factor XIII level decreased to 48%, we administered factor XIII products (Fibrogammin P; CSL Behring, King of Prussia, PA) after the surgery. Although its utility and safety in patients with renal failure and/or transplantation are unclear, urine leakage stopped after the infusion of fibrogammin without any side effects. This is the first case report of the use of factor XIII for refractory urine leakage after kidney transplantation. Although further studies are needed, administration of factor XIII products could be one option for refractory urine leakage after transplantation.
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5
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Hanaoka A, Naganuma T, Kabata D, Takemoto Y, Uchida J, Nakatani T, Shintani A. Selective plasma exchange in ABO-incompatible kidney transplantation: comparison of substitution with albumin and partial substitution with fresh frozen plasma. Sci Rep 2020; 10:1434. [PMID: 31996738 PMCID: PMC6989510 DOI: 10.1038/s41598-020-58436-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 01/13/2020] [Indexed: 12/13/2022] Open
Abstract
We have performed selective plasma exchange (SePE) as apheresis before ABO-incompatible kidney transplantation since 2015. In this study, we divided the SePE sessions into two groups, those using albumin alone (Group A) and those partially using fresh frozen plasma (FFP) (Group F), and compared their clinical efficacies. A total of 58 sessions of SePE (Group A: n = 41, Group F: n = 17) were performed in 30 recipients of ABOi kidney transplantation during the study period and the decrease in isoagglutinin titers, changes in the levels of serum IgG and IgM as well as coagulation factors (fibrinogen, factor XIII), and incidence of side effects were retrospectively compared. There was a more significant decrease of isoagglutinin titers in Group F compared to Group A. Immunoglobulins and coagulants were replenished in Group F. Meanwhile, the incidence of side effects was significantly higher in Group F. SePE using FFP, which can effectively decrease isoagglutinins titers and replenish immunoglobulin and coagulation factors, may be a beneficial treatment modality as apheresis before ABO-incompatible kidney transplantation, in spite of a disadvantage that there are many side effects.
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Affiliation(s)
- Ako Hanaoka
- Department of Medical Devices, Osaka City University Hospital, Osaka, Japan
| | - Toshihide Naganuma
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | - Daijiro Kabata
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yoshiaki Takemoto
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Junji Uchida
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tatsuya Nakatani
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
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Uchida J, Kosoku A, Naganuma T, Tanaka T, Nakatani T. Latest insights on ABO-incompatible living-donor renal transplantation. Int J Urol 2019; 27:30-38. [PMID: 31522462 PMCID: PMC7004137 DOI: 10.1111/iju.14109] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/23/2019] [Indexed: 12/13/2022]
Abstract
This review summarizes the latest insights on ABO‐incompatible living‐donor renal transplantation. Desensitization protocols and clinical outcomes were investigated, and a comparison was made with kidney‐paired donation, which is not permitted in Japan for ethical reasons. Although renal transplantation is greatly beneficial for most patients with end‐stage kidney disease, many of these patients must remain on dialysis therapy for extended periods due to the scarcity of organs from deceased donors. ABO blood type incompatibility was once believed to be a contraindication to renal transplantation due to the increased risk for antibody‐mediated rejection and early graft loss attributable to isoagglutinins. Recently, pretransplant desensitization strategies, such as removal of isoagglutinins and antibody‐producing cells, have achieved successful outcomes, although it remains unclear whether graft survival and patient morbidity are equivalent to those for ABO‐compatible renal transplantation. The present review suggested that ABO‐incompatible living‐donor renal transplantation might be a favorable radical renal replacement therapy for patients with end‐stage kidney disease.
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Affiliation(s)
- Junji Uchida
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akihiro Kosoku
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Toshihide Naganuma
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tomoaki Tanaka
- Department of Urology, Suita Municipal Hospital, Suita, Japan
| | - Tatsuya Nakatani
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
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7
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Hanaoka A, Naganuma T, Takemoto Y, Uchida J, Nakatani T, Kabata D, Shintani A. Efficacy of selective plasma exchange as pre-transplant apheresis in ABO-incompatible kidney transplantation. RENAL REPLACEMENT THERAPY 2019. [DOI: 10.1186/s41100-019-0204-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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8
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Marlu R, Malvezzi P, Seyve L, Jouve T, Maurizi J, Defendi F, Carron P, Christophe M, Le Gouellec A, Polack B, Rostaing L. Effect of double-filtration plasmapheresis for antibody-mediated rejection on hemostasis parameters and thrombin generation. Thromb Res 2018; 166:113-121. [DOI: 10.1016/j.thromres.2018.04.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 03/31/2018] [Accepted: 04/16/2018] [Indexed: 12/11/2022]
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9
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Miyamoto S, Ohkubo A, Seshima H, Komori S, Yamamoto M, Maeda T, Itagaki A, Yamamoto H, Nojima K, Iimori S, Naito S, Kurashima N, Sohara E, Rai T, Uchida S, Okado T. Selective Plasma Exchange for the Removal of Pemphigus Autoantibodies, Fibrinogen, and Factor XIII in Pemphigus Vulgaris. Ther Apher Dial 2017; 21:226-231. [DOI: 10.1111/1744-9987.12555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Satoko Miyamoto
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Atsushi Ohkubo
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Hiroshi Seshima
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Shigeto Komori
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Motoki Yamamoto
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Takuma Maeda
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Ayako Itagaki
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Hiroko Yamamoto
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Kohei Nojima
- Department of Dermatology; Tokyo Medical and Dental University; Tokyo Japan
| | - Soichiro Iimori
- Department of Nephrology; Tokyo Medical and Dental University; Tokyo Japan
| | - Shotaro Naito
- Department of Nephrology; Tokyo Medical and Dental University; Tokyo Japan
| | - Naoki Kurashima
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Eisei Sohara
- Department of Nephrology; Tokyo Medical and Dental University; Tokyo Japan
| | - Tatemitsu Rai
- Department of Nephrology; Tokyo Medical and Dental University; Tokyo Japan
| | - Shinichi Uchida
- Department of Nephrology; Tokyo Medical and Dental University; Tokyo Japan
| | - Tomokazu Okado
- Department of Nephrology; Tokyo Medical and Dental University; Tokyo Japan
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10
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Abdulrahman Z, Bennani Naciri H, Allal A, Sallusto F, Debiol B, Esposito L, Guilbeau-Frugier C, Kamar N, Rostaing L. Long-term outcomes after ABO-incompatible kidney transplantation; a single-center French study. J Nephropathol 2017. [DOI: 10.15171/jnp.2017.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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11
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Schwartz J, Padmanabhan A, Aqui N, Balogun RA, Connelly-Smith L, Delaney M, Dunbar NM, Witt V, Wu Y, Shaz BH. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice-Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Seventh Special Issue. J Clin Apher 2017; 31:149-62. [PMID: 27322218 DOI: 10.1002/jca.21470] [Citation(s) in RCA: 276] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating, and categorizing indications for the evidence-based use of therapeutic apheresis in human disease. Since the 2007 JCA Special Issue (Fourth Edition), the Committee has incorporated systematic review and evidence-based approaches in the grading and categorization of apheresis indications. This Seventh Edition of the JCA Special Issue continues to maintain this methodology and rigor to make recommendations on the use of apheresis in a wide variety of diseases/conditions. The JCA Seventh Edition, like its predecessor, has consistently applied the category and grading system definitions in the fact sheets. The general layout and concept of a fact sheet that was used since the fourth edition has largely been maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of therapeutic apheresis in a specific disease entity. The Seventh Edition discusses 87 fact sheets (14 new fact sheets since the Sixth Edition) for therapeutic apheresis diseases and medical conditions, with 179 indications, which are separately graded and categorized within the listed fact sheets. Several diseases that are Category IV which have been described in detail in previous editions and do not have significant new evidence since the last publication are summarized in a separate table. The Seventh Edition of the JCA Special Issue serves as a key resource that guides the utilization of therapeutic apheresis in the treatment of human disease. J. Clin. Apheresis 31:149-162, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | - Anand Padmanabhan
- Blood Center of Wisconsin, Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nicole Aqui
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rasheed A Balogun
- Division of Nephrology, University of Virginia, Charlottesville, Virginia
| | - Laura Connelly-Smith
- Department of Medicine, Seattle Cancer Care Alliance and University of Washington, Seattle, Washington
| | - Meghan Delaney
- Bloodworks Northwest, Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Volker Witt
- Department for Pediatrics, St. Anna Kinderspital, Medical University of Vienna, Vienna, Austria
| | - Yanyun Wu
- Bloodworks Northwest, Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Beth H Shaz
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York.,New York Blood Center, Department of Pathology.,Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
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12
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Miyamoto S, Ohkubo A, Seshima H, Maeda T, Itagaki A, Kurashima N, Iimori S, Naito S, Sohara E, Rai T, Uchida S, Okado T. Removal Dynamics of Immunoglobulin and Fibrinogen by Conventional Plasma Exchange, Selective Plasma Exchange, and a Combination of the Two. Ther Apher Dial 2016; 20:342-7. [DOI: 10.1111/1744-9987.12465] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Indexed: 12/26/2022]
Affiliation(s)
- Satoko Miyamoto
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University
| | - Atsushi Ohkubo
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University
| | - Hiroshi Seshima
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University
| | - Takuma Maeda
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University
| | - Ayako Itagaki
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University
| | - Naoki Kurashima
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University
| | - Soichiro Iimori
- Department of Nephrology; Tokyo Medical and Dental University
| | - Shotaro Naito
- Department of Nephrology; Tokyo Medical and Dental University
| | - Eisei Sohara
- Department of Nephrology; Tokyo Medical and Dental University
| | - Tatemitsu Rai
- Department of Nephrology; Tokyo Medical and Dental University
| | - Shinichi Uchida
- Department of Nephrology; Tokyo Medical and Dental University
| | - Tomokazu Okado
- Department of Nephrology; Tokyo Medical and Dental University
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13
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Rostaing L, Allal A, Del Bello A, Sallusto F, Esposito L, Doumerc N, Debiol B, Delas A, Game X, Kamar N. Treatment of large plasma volumes using specific immunoadsorption to desensitize ABO-incompatible kidney-transplant candidates. J Nephropathol 2016; 5:90-7. [PMID: 27540536 PMCID: PMC4961822 DOI: 10.15171/jnp.2016.17] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/14/2016] [Indexed: 12/11/2022] Open
Abstract
Background
ABO-incompatible (ABOi) kidney-transplantation has very good long-term results, i.e. similar to those observed for living-kidney ABO-compatible transplantation. This is because patients are desensitized at pretransplant using apheresis and rituximab therapy, with tacrolimus-based immunosuppression.
Objectives
To assess the efficacy of a single, pretransplant (Day –1), specific immunoadsorption session using Glycosorb® columns (anti-A or anti-B; Glycorex Sweden) to treat large volumes of plasma (up to 18 L).
Patients and Methods
Prospective single-center study evaluating 12 consecutive patients (6 males), aged 40 (23–59) years. Incompatibilities were A into 0 (8), B into 0 (3), and AB into 0 (1). Pretransplant desensitization relied on rituximab (D–30), tacrolimus, mycophenolic acid, and steroids (all started on D–13), and a single session of specific immunoadsorption on D–1. Immunoadsorption was coupled in tandem with a hemodialysis session.
Results
Overall, 15 L (11–18) of plasma were treated per patient, i.e., 0.2 (0.11–0.36 L/kg). Isoagglutinin titers were 1/16 (1/5–1/64) before the procedure, decreasing after 6 hours to 1/5 (1/1–1/16 P = 0.008), and to 1/2 (1/1–1/8; P = 0.05) at completion of the session. The next day, i.e., the day of transplantation, there was no rebound of isoagglutinins [1/4 (1/1–1/5); P = ns]. The procedure was well tolerated with no side-effects and no significant changes in hemoglobin level, platelet counts, fibrinogen, or albumin levels.
Conclusions
For ABOi kidney-transplantation, a single, longer, specific immunoadsorption session was very efficient at 1-day pre-transplantation with no rebound. These results should be confirmed when isoagglutinin titers are higher (≥120).
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Affiliation(s)
- Lionel Rostaing
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France ; INSERM U563, IFR-BMT, CHU Purpan, Toulouse, France ; Université Toulouse III Paul Sabatier, Toulouse, France
| | - Asma Allal
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Federico Sallusto
- Department of Urology, Andrology, and Transplantation, CHU Rangueil, Toulouse, France
| | - Laure Esposito
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Nicolas Doumerc
- Department of Urology, Andrology, and Transplantation, CHU Rangueil, Toulouse, France
| | - Bénédicte Debiol
- Etablissement Français du Sang de Midi-Pyrénées, CHU Purpan, Toulouse, France
| | - Audrey Delas
- Laboratory of Histopathology, CHU Rangueil, Toulouse, France
| | - Xavier Game
- Université Toulouse III Paul Sabatier, Toulouse, France ; Department of Urology, Andrology, and Transplantation, CHU Rangueil, Toulouse, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France ; Université Toulouse III Paul Sabatier, Toulouse, France ; INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France
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Acute Disseminated Encephalomyelitis. J Clin Apher 2016; 31:163-202. [PMID: 27322219 DOI: 10.1002/jca.21474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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15
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Naciri Bennani H, Abdulrahman Z, Allal A, Sallusto F, Delarche A, Game X, Esposito L, Doumerc N, Debiol B, Kamar N, Rostaing L. Early post-transplant complications following ABO-incompatible kidney transplantation. J Nephropathol 2015; 5:19-27. [PMID: 27047806 PMCID: PMC4790183 DOI: 10.15171/jnp.2016.04] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 12/15/2015] [Indexed: 01/18/2023] Open
Abstract
Background: Living-kidney transplantation is increasing because of the scarcity of kidneys from deceased donors and the increasing numbers of patients on waiting lists for a kidney transplant. Living-kidney transplantation is now associated with increased long-term patient- and allograft-survival rates.
Objectives: The purpose of this retrospective study was to identify, in a cohort of 44 ABO-incompatible (ABOi) live-kidney transplant patients, the main complications that occurred within 6 months post-transplantation, and to compare these findings with those from 44 matched ABO-compatible (ABOc) live-kidney transplant patients who were also from our center.
Patients and Methods: This single-center retrospective study assessed post-transplantation complications in 44 ABO-i versus 44 matched ABO-c patients. All patients were comparable at baseline except that ABO-i patients had greater immunological risks.
Results: During the 6-month post-transplant period, more ABO-i patients presented with postoperative bleeds, thus requiring significantly more blood transfusions. Bleeds were associated with significantly lower values of fibrinogen, platelets, prothrombin time, and hemoglobin levels. Surgical complications, patient- and graft-survival rates, and kidney-function statuses were similar between both groups at 6 months post-transplantation.
Conclusions: We conclude that impairment of hemostatic factors at pre-transplant explained the increased risk of a post-transplant bleed in ABO-i patients.
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Affiliation(s)
- Hamza Naciri Bennani
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Zhyiar Abdulrahman
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Asma Allal
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Federico Sallusto
- Department of Urology, Andrology, and Transplantation, CHU Rangueil, Toulouse, France
| | - Antoine Delarche
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Xavier Game
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France ; Department of Urology, Andrology, and Transplantation, CHU Rangueil, Toulouse, France
| | - Laure Esposito
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Nicolas Doumerc
- Department of Urology, Andrology, and Transplantation, CHU Rangueil, Toulouse, France
| | - Bénédicte Debiol
- Etablissement Français du Sang de Midi-Pyrénées, CHU Purpan, Toulouse, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France ; INSERM U563, IFR-BMT, CHU Purpan, Toulouse, France ; Université Paul Sabatier, Toulouse, France
| | - Lionel Rostaing
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France ; INSERM U563, IFR-BMT, CHU Purpan, Toulouse, France ; Université Paul Sabatier, Toulouse, France
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Abstract
Kidney transplantation across the ABO blood group barrier was long considered a contraindication for transplantation, but in an effort to increase donor pools, specific regimens for ABO-incompatible (ABOi) transplantation have been developed. These regimens are now widely used as an integral part of the available treatment options. Various desensitization protocols, commonly based on transient depletion of preformed anti-A and/or anti-B antibodies and modulation of B-cell immunity, enable excellent transplant outcomes, even in the long-term. Nevertheless, the molecular mechanisms behind transplant acceptance facilitated by a short course of anti-humoral treatment are still incompletely understood. With the evolution of efficient clinical programmes, tailoring of recipient preconditioning based on individual donor-recipient blood type combinations and the levels of pretransplant anti-A/B antibodies has become possible. In the context of low antibody titres and/or donor A2 phenotype, immunomodulation and/or apheresis might be dispensable. A concern still exists, however, that ABOi kidney transplantation is associated with an increased risk of surgical and infectious complications, partly owing to the effects of extracorporeal treatment and intensified immunosuppression. Nevertheless, a continuous improvement in desensitization strategies, with the aim of minimizing the immunosuppressive burden, might pave the way to clinical outcomes that are comparable to those achieved in ABO-compatible transplantation.
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Biesenbach P, Eskandary F, Ay C, Wiegele M, Derfler K, Schaden E, Haslacher H, Oberbauer R, Böhmig GA. Effect of combined treatment with immunoadsorption and membrane filtration on plasma coagulation-Results of a randomized controlled crossover study. J Clin Apher 2015; 31:29-37. [DOI: 10.1002/jca.21399] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 03/22/2015] [Accepted: 04/06/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Peter Biesenbach
- Division of Nephrology and Dialysis; Department of Medicine III; Medical University of Vienna; Vienna Austria
| | - Farsad Eskandary
- Division of Nephrology and Dialysis; Department of Medicine III; Medical University of Vienna; Vienna Austria
| | - Cihan Ay
- Division of Hematology and Hemostaseology; Department of Medicine I; Medical University Vienna; Vienna Austria
| | - Marion Wiegele
- Department of Anaesthesia; General Intensive Care and Pain Control, Medical University Vienna; Vienna Austria
| | - Kurt Derfler
- Division of Nephrology and Dialysis; Department of Medicine III; Medical University of Vienna; Vienna Austria
| | - Eva Schaden
- Department of Anaesthesia; General Intensive Care and Pain Control, Medical University Vienna; Vienna Austria
| | - Helmuth Haslacher
- Department of Laboratory Medicine; Medical University of Vienna; Vienna Austria
| | - Rainer Oberbauer
- Division of Nephrology and Dialysis; Department of Medicine III; Medical University of Vienna; Vienna Austria
| | - Georg A. Böhmig
- Division of Nephrology and Dialysis; Department of Medicine III; Medical University of Vienna; Vienna Austria
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Focosi D. Acquired factor XIII deficiency after desensitization as a potential contributor to postoperative bleeding: more than meets the eye. Transpl Int 2015; 28:246-7. [DOI: 10.1111/tri.12469] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Daniele Focosi
- Department of Translational Research; University of Pisa; Pisa Italy
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19
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Ohdan H. How can we minimize bleeding complications in ABO-incompatible kidney transplant recipients? Transpl Int 2014; 28:22-4. [DOI: 10.1111/tri.12447] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 09/02/2014] [Indexed: 12/29/2022]
Affiliation(s)
- Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery; Applied Life Science; Institute of Biomedical and Health Science; Hiroshima University; Hiroshima Japan
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Early clinical complications after ABO-incompatible live-donor kidney transplantation: a national study of Medicare-insured recipients. Transplantation 2014; 98:54-65. [PMID: 24978035 DOI: 10.1097/tp.0000000000000029] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Descriptions of the sequelae of ABO-incompatible (ABOi) kidney transplantation are limited to single-center reports, which may lack power to detect important effects. METHODS We examined U.S. Renal Data System registry data to study associations of ABOi live-donor kidney transplantation with clinical complications in a national cohort. Among 14,041 Medicare-insured transplants in 2000 to 2007, 119 non-donor-A2 ABOi transplants were identified. A2-incompatible (n=35) transplants were categorized separately. Infection and hemorrhage events were identified by diagnosis codes on billing claims. Associations of ABO incompatibility with complications were assessed by multivariate Cox regression. RESULTS Recipients of ABOi transplants experienced significantly (P<0.05) higher incidence of wound infections (12.7% vs. 7.3%), pneumonia (7.6% vs. 3.8%), and urinary tract infections (UTIs) or pyelonephritis (24.5% vs. 15.3%) in the first 90 days compared with ABO-compatible recipients. In adjusted models, ABO incompatibility was associated with twice the risk of pneumonia (adjusted hazard ratio [aHR], 2.22; 95% confidence interval [CI], 1.14-4.33) and 56% higher risk of UTIs or pyelonephritis (aHR, 1.56; 95% CI, 1.05-2.30) in the first 90 posttransplantation days, and 3.5 times the relative risk of wound infections in days 91 to 365 (aHR, 3.55; 95% CI, 1.92-6.57). ABOi recipients, 19% of whom underwent pre- or peritransplant splenectomy, experienced twice the adjusted risk of early hemorrhage (aHR, 1.96; 95% CI, 1.19-3.24). A2-incompatible transplantation was associated only with early risk of UTIs or pyelonephritis. CONCLUSION ABOi transplantation offers patients with potential live donors an additional transplant option but with higher risks of infectious and hemorrhagic complications. Awareness of these complications may help improve protocols for the management of ABOi transplantation.
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